amor-ipat

Active Management of Risk in Pregnancy at Term

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"Pregnancy is getting company inside one's skin."

- Maggie Scarf

AMOR-IPAT Glossary

AMOR-IPAT (The Active Management of Risk in Pregnancy at Term) – A preventive method of obstetric care that uses each gravida’s risk factors for cesarean delivery to estimate a patient-specific UL-OTD. If a gravida has not gone into labor as she approaches her UL-OTD, then she is offered preventive labor induction. If preventive labor induction is scheduled, but the gravida’s uterine cervix in unfavorable (modified Bishop’s score < 6), then modern methods of cervical ripening are used prior to the use of oxytocin.

CPD (Cephalo-pelvic Disproportion) – CPD is the condition where the fetal head is not able to pass through the maternal pelvis. CPD is the most frequent cause of “failure to progress (FTP),” and FTP is the most common indication for cesarean delivery. We prefer to use the term CPD rather than FTP because CPD describes a potentially predictable (and therefore potentially preventable) underlying etiology.

eIOL (Elective Induction of Labor) – An induction based on neither an ACOG indication or AMOR-IPAT criteria but simply on patient or provider choice.

iIOL (Indicated Induction of Labor) – An induction of labor based on an accepted clinical reason. The American College of Obstetrics and Gynecology has published a list of accepted indications.

LL-OTD (The Lower Limit of the Optimal Time of Delivery) – Within the AMOR-IPAT method of care, the LL-OTD is defined as 38 weeks 0 days gestation. For the safe use of AMOR-IPAT, pregnancy dating must involve close agreement between the last menstrual period dating and at least one 6-20 week ultrasound, or two 6-20 week ultrasounds. Increased rates of neonatal pulmonary morbidity have not been found following the use of AMOR-IPAT preventive labor induction in the 38th week of pregnancy.

OTD (The Optimal Time of Delivery) – A gravida’s OTD is the gestational age range wherein the onset of labor provides the optimal set of birth outcomes for mother and baby.

pIOL (Preventive Induction of Labor) – An induction based on a gravida’s risk profile. A preventive induction is usually initiated prior to the development of a clinical state that meets the criteria for an indicated induction.

UL-OTD (The Upper Limit of the Optimal Time of Delivery) – Within the AMOR-IPAT method of care, the UL-OTD is based on cumulative risk and is a variable patient-specific gestational age above which the risk of cesarean delivery begins to significantly increase. The UL-OTD is estimated by sorting risk factors into two major categories (those contributing to CPD or those contributing to UPI), converting the odds ratio for cesarean delivery for each risk factor into time units (number of days), and subtracting the cumulative number of days in each risk category for each patient from 41 weeks 0 days gestation. The lower of the two category-specific gestational ages is the patient’s final UL-OTD, but the final UL-OTD is never less than 38 weeks 0 days.

UPI (Utero-placental Insufficiency) – UPI is the condition where the fetus is inadequately supported by the utero-placental unit during labor. UPI is the most frequent cause of “non-reassuring fetal states (NRFS), and NRFS is the second most common indication for cesarean delivery. We prefer to use the term UPI rather than NRFS because UPI describes a potentially predictable (and therefore potentially preventable) underlying etiology.